Registration Form

Please Fill out Form, Print, Sign and Mail or Hand Submit with a $125.00 registration fee to:

Early Enrichment Center, 500 East Saddle River Road, Upper Saddle River, NJ 07458

Child's First Name
Child's Last Name
Sex	Male  Female
Date of Birth
Home Phone Number
Street Address
Address (cont.)
City
State
Zip/Postal Code
Father's Name
Father's Occupation
Father's Work Phone
Father's Cell Phone
Father's Work Address
Mother's Name
Mother's Occupation
Mother's Work Phone
Mother's Cell Phone
Mother's Work Address

          List any allergies:

          List any medications prescribed to your child for allergies:

Program Selection (Place X in appropriate Box)
Age	Schedule	Hours
Toddler	2 Day	AM
3 Year Old	3 Day	PM
PRE-K	5 Day	Full Day
Kindergarten	5 am / 2 pm	5 am / 3 pm

Extended Hours:

8:00—9:00 AM Number of Days

3:00—4:00 PM Number of Days

Extended Days:

MON

TUES

WED

THURS

FRI

A NON REFUNDABLE registration fee of $125.00 and a NON REFUNDABLE one month security payment is due with this application to hold placement for your child. NO REFUNDS OR TIME ADJUSTMENTS CAN BE MADE FOR ILLNESS, HOLIDAYS, VACATIONS, INCLEMENT WEATHER, SCHOOL CLOSINGS OR EARLY WITHDRAWAL. Early withdrawal pertains to the time period from the date on the registration form to the last day of May of the school year designated on this registration form. In the event of early withdrawal, the security payment will be applied to the last month of attendance, IF NOTICE IS RECEIVED (30) DAYS PRIOR TO WITHDRAWAL. If early withdrawal takes place before school starts, the security payment may be applied to September. Tuition money is due the first day of each month in advance of attendance. There will be a $30.00 charge on any returned check. Tuition 30 days past due will be charged a $50.00 late fee. Any Account that goes into collection will be charged for past due tuition plus the collection fee.

I have read and agree to the terms on this registration form.

Date

________

Parent Signature

__________________________

The Early Enrichment Center accepts children of any race, religion, and ethnic origin. We reserve the right to discontinue enrollment due to account delinquency, or inability of a child or parent to adjust to the school program or policies.